NPI | 1336110600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 59459) |
Additional Taxonomies | 208D00000X General Practice (Licence: ND 10065) |
Enumeration Date | 2006-01-27 |
Last Update Date | 2021-06-10 |